title: Critically ill patients in emergency department may be characterized by low amplitude and high variability of amplitude of pulse photoplethysmography.
abstract: BACKGROUND
  The aim of the present pilot study was to determine if pulse photoplethysmography amplitude (PPGA) could be used as an indicator of critical illness and as a predictor of higher need of care in emergency department patients.
  
  
  METHODS
  This was a prospective observational study. We collected vital signs and one minute of pulse photoplethysmograph signal from 251 consecutive patients admitted to a university hospital emergency department. The patients were divided in two groups regarding to the modified Early Warning Score (mEWS): > 3 (critically ill) and ≤ 3 (non-critically ill). Photoplethysmography characteristics were compared between the groups.
  
  
  RESULTS
  Sufficient data for analysis was acquired from 212 patients (84.5%). Patients in critically ill group more frequently required intubation and invasive hemodynamic monitoring in the ED and received more intravenous fluids. Mean pulse photoplethysmography amplitude (PPGA) was significantly lower in critically ill patients (median 1.105 [95% CI of mean 0.9946-2.302] vs. 2.476 [95% CI of mean 2.239-2.714], P = 0.0257). Higher variability of PPGA significantly correlated with higher amount of fluids received in the ED (r = 0.1501, p = 0.0296).
  
  
  CONCLUSIONS
  This pilot study revealed differences in PPGA characteristics between critically ill and non-critically ill patients. Further studies are needed to determine if these easily available parameters could help increase accuracy in triage when used in addition to routine monitoring of vital signs.
authors.affiliation: Department of Anesthesia and Intensive Care, Helsinki University Central Hospital, Helsinki, Finland. jussi.pirneskoski@helsinki.fi
authors.forename: Jussi
authors.initials: J
authors.lastname: Pirneskoski
authors.forename: Veli-Pekka
authors.initials: VP
authors.lastname: Harjola
authors.forename: Petri
authors.initials: P
authors.lastname: Jeskanen
authors.forename: Lari
authors.initials: L
authors.lastname: Linnamurto
authors.forename: Simo
authors.initials: S
authors.lastname: Saikko
authors.forename: Jouni
authors.initials: J
authors.lastname: Nurmi
mesh_terms: D000328:Adult; D000368:Aged; D016638:Critical Illness; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017156:Photoplethysmography; D010865:Pilot Projects; D011446:Prospective Studies; D014218:Triage